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CareSourceMedicaid · Billing Codes · Pharmacy · OH · Pharmacy, Oncology, Infectious Disease +2 moreHigh impact

[Ohio] Requirements for Including National Drug Code

Act
by Jul 25, 2025
Effective date
Jul 25, 2025
Identified
May 9, 2026

Summary

Ohio Medicaid now requires National Drug Codes (NDC) to be included in the LIN segment of 837 claims for specific HCPCS and CPT drug codes (B4164-B4240, J0120-J9999, Q0138-Q9999, S0145-S5001, CPT 90281-90399). Notably, Q4100-Q4499 skin substitutes and RSV vaccine codes 90380-90381 are EXCLUDED from NDC requirements. The CTP segment must also be used for J-series, B-series, Q-series, and S-series drug codes.

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What to do

by Jul 25, 2025 · 6 steps
01Billing team must update the 837 claim submission process in billing software to automatically include NDC codes in the LIN segment (2410 loop) for all B4164-B4240, J0120-J9999, Q0138-Q9999, S0145-S5001, and CPT 90281-90399 codes.
02Ensure CTP segment is populated with drug quantity and NDC count for J-series, B-series, Q-series, and S-series drug codes.
03Configure system to EXCLUDE NDC requirement for Q4100-Q4499 (skin substitutes) and RSV vaccine CPT codes 90380 and 90381.
04Verify compliance in billing system testing before the effective date.
05Non-compliance will result in claim denials or post-adjudication issues.
06Assign pharmacy billing staff to monitor quarterly ODM CPT/HCPCS code updates on the ODM Companion Guides website.

Codes mentioned

B4164B4240J0120J9999Q0138Q9999Q4100Q4499S0145S500190281903999038090381

Original notice

[Ohio] Requirements for Including National Drug Code
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Ohio] Vaccine for Children Program Administration Billing GuidanceHighEffective Jul 1, 2026 · Claims & Billing[Ohio] Beyfortus Drug Billing UpdateHighEffective May 1, 2025 · Pharmacy[Ohio] Requirements for Including NDC with Certain HCPCS and CPT codesHighNo effective date · PharmacyBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesPharmacyOncologyInfectious DiseasePediatricsAllergy & ImmunologyCode B4164Code B4240Code J0120Code J9999Code Q0138Code Q9999Code Q4100Code Q4499Code S0145Code S5001Code 90281Code 90399Code 90380Code 90381

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